Provider Demographics
NPI:1932883782
Name:PROSPERITY LIFE SERVICES
Entity Type:Organization
Organization Name:PROSPERITY LIFE SERVICES
Other - Org Name:ROOTED IN PROSPERITY WELLNESS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:513-204-9646
Mailing Address - Street 1:1 N COMMERCE PARK DR STE 331
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3273
Mailing Address - Country:US
Mailing Address - Phone:513-204-9646
Mailing Address - Fax:
Practice Address - Street 1:1 N COMMERCE PARK DR STE 331
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3273
Practice Address - Country:US
Practice Address - Phone:513-204-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty